al aspirates were inoculated onto chocolate plates. Antimicrobial susceptibilities were obtained using the Microscan walkaway system. Medical records of patients who met the criteria for Pseudomonas aeruginosa pneumonia, sinusitis, and otitis media were reviewed. Paying close attention to the following variables: age, gender, race, self-reported risk of HIV acquisition, CD4+ cell count, previous opportunistic infections, antiviral therapy, use of Pneumocystic carinii pneumonia prophylaxis, prior pulmonary infection, signs and symptoms of disease on presentation, therapeutic interventions, and clinical outcome, including death. Specific antiviral regimens varied, most subjects were on a regimen that included one or two reverse transcriptase inhibitors. Of the two patients who developed invasive Pseudomonas aeruginosa infections following the routine use of HAART, one was receiving a three-drug regimen, including a protease inhibitor, and the other did not comply with his antiviral therapy. Pseudomonas aeruginosa is an important cause of recurrent, community-acquired sinopulmonary disease among HIV infected patients, even in the absence of traditional risk factors. Several studies delineating the potential risks of pseudomonal infection in the HIV population have found corticosteroid use, recent antibiotic exposure, PCP prophylaxis with TMP-SMX, prior hospitalization, and neutropenia to be predictive of Pseudomonas aeruginosa infection. The profound immunosuppression inherent in advanced HIV disease may in fact be the most important risk factor for Pseudomonas aeruginosa infection. Patients with pseudomonal disease were severely immunocompromised and suffered from frequent opportunistic infections. Cell-mediated immunity is thought to play a vital role in defending against Pseudomonas aeruginosa infection. Therefore, it is not surprising that the loss of functionally active T cells that occurs with progressive HIV infecti...
